OIG Investigation and Reviews team continues to identify waste, fraud and abuse.

The Investigations & Reviews (I&R) Division continues to receive hotline referrals and managed care organization referrals related to personal care attendants. For the quarter, 40 percent of preliminary referrals were for attendants billing for services not rendered, falsifying documentation and billing for attendant care while the client is an inpatient at a hospital or nursing facility. The OIG continues to investigate attendant care cases and recommend enforcement action based on findings.

A sample of case results for Provider Investigations settled by Litigation for this quarter include:

• As part of an OIG initiative, investigators identified providers in San Antonio and Converse who were billing over the daily allowable amount for private duty nursing, and in some instances, submitting duplicate claims. Settlements in the fourth quarter resulted in $86,531 in repayments for the two cases.

• The OIG settled four cases involving dental providers. The providers’ most common errors were upcoding services, providing medically unnecessary services and not maintaining appropriate medical records. A Houston provider agreed to a settlement of $44,236, a San Antonio dentist agreed to repay $25,881, and an Arlington provider agreed to pay $13,303. A fourth investigation resulted in a provider located in Tyler agreeing to repay $19,422.